Spectrum ePay Merchant Account Application Form
Complete sections for Underwriting.
AGENT INFORMATION
Provide your merchant account agent’s details.
Agent’s Name
*
Agent’s Email
*
Agent’s Phone
*
BUSINESS INFORMATION
Provide your company details.
Type of Corporation
*
Sole Proprietorship
LLC/LLP
Corporation
Non-Profit
Legal Name of Business
*
Federal Tax ID (EIN)
*
Business Start Date
*
-
Month
-
Day
Year
Date
Legal Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
DBA Name
*
DBA Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Business Website
Business Email
*
example@example.com
Business Contact Name
*
First Name
Last Name
Business Phone
*
Please enter a valid phone number.
Customer Service Phone
*
Please enter a valid phone number.
BUSINESS BANK ACCOUNT INFORMATION
Provide your banking details.
Bank Name
*
Full Business Bank Routing Number
*
Full Business Bank Account Number
*
OWNERSHIP INFORMATION (for all persons with 25% or more ownership)
Add information for each owner with 25% or more ownership.
Ownership Information
*
CREDIT CARD PROCESSING INFORMATION
Provide your business's credit card processing details.
Does your business currently accept cards?
*
Yes
No
Monthly Credit Card Volume (USD)
*
AMEX Monthly Volume (USD)
*
High Ticket Amount (USD)
*
Average Ticket (USD)
*
Retail In Person Sales (%)
*
Consumer Internet Sales (%)
*
B2B Internet Sales (%)
*
B2B MOTO Sales (%)
*
Days to Delivery
*
Return/Refund Policy
*
Products Sold
*
CBD/Delta
THCA
Kratom
Kava
Mushrooms
Hemp Seeds
Tobacco/Nicotine
Nutraceuticals
Peptides
Please specify other product
Products/Services Description
*
REQUIRED ATTACHMENT UPLOADS
Upload all required documents. Only PDF, JPG, JPEG, PNG, ZIP, XLSX, XLS, CSV formats accepted.
CORE DOCUMENTS
Upload all required documents. Only PDF, JPG, JPEG, PNG, ZIP, XLSX, XLS, CSV formats accepted.
Government-Issued Photo ID (Unexpired US State ID, Driver’s License, or Passport)
*
Upload a File
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of
Business Check or Signed Bank Letter (dated within 30 days)
*
Upload a File
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of
Business Banking (last three months PDF business e-statement or personal statement for brand new businesses)
*
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of
Business Banking (last three months PDF business e-statement or personal statement for brand new businesses)
*
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of
Business Banking (last three months PDF business e-statement or personal statement for brand new businesses)
*
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of
Merchant Processing PDF Statement (last month’s PDF e-statement)
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of
Merchant Processing PDF Statement (two months ago PDF e-statement)
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of
Merchant Processing PDF Statement (three months ago PDF e-statement)
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of
Business License
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of
SS-4 or 147C (EIN Confirmation)
*
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of
Articles of Incorporation/Organization or Certificate of Formation
*
Upload a File
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of
Operating Agreement/Bylaws
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of
Inventory Photo (photo of all products in stock inside warehouse or office)
*
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of
B2B MOTO
Upload all required documents. Only PDF, JPG, JPEG, PNG, ZIP, XLSX, XLS, CSV formats accepted.
Lease Agreement under DBA Address
Upload a File
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of
Marketing Materials (Branded Brochure/Catalog with Inventory & Pricing)
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of
Inventory Purchase Order
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of
Fulfillment Agreement
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of
TOBACCO/NICOTINE DOCUMENTS
Upload all required documents. Only PDF, JPG, JPEG, PNG, ZIP, XLSX, XLS, CSV formats accepted.
Tobacco License
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of
Utility Bill under DBA Address (dated within 30 days)
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of
CBD DOCUMENTS
Upload all required documents. Only PDF, JPG, JPEG, PNG, ZIP, XLSX, XLS, CSV formats accepted.
Hemp License
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of
CBD/Kratom Product List Spreadsheet (original format, no share links)
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of
CBD PDF COAs (ZIP File)
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of
KRATOM DOCUMENTS
Upload all required documents. Only PDF, JPG, JPEG, PNG, ZIP, XLSX, XLS, CSV formats accepted.
Kratom Product List Spreadsheet (original format, no share links)
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of
Kratom PDF COAs (ZIP File)
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of
Submit Application
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